Individual
ANGELIQUE ONTIVEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
78870 LA PALMA DR, LA QUINTA, CA 92253-3839
(760) 578-8030
Mailing address
78870 LA PALMA DR, LA QUINTA, CA 92253-3839
(760) 578-8030
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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